Bottom Line:
The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93).Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.

Affiliation: Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark. stine_lund@dadlnet.dk.

ABSTRACT

Background: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse.

Objective: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting.

Methods: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality.

Results: Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).

Conclusions: Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.

Mentions:
The study comprised 24 primary health care facilities and pregnant women attending antenatal care at these facilities. Clusters eligible for randomization were the four primary health care facilities in each of the six districts of Unguja Island with the most antenatal care visits in the previous year and a midwife among the staff. There were no major differences between included facilities. They were all primary health care facilities staffed with 1 or 2 midwives and access to basic infrastructure and equipment. The distribution of facilities in relation to hospitals providing Emergency Obstetric and Neonatal care was the same in intervention and control clusters (Figure 1). The eligibility criteria for participants was pregnant women who attended their first antenatal care visit at 1 of the 24 primary health care facilities regardless of gestational age or mobile phone ownership. A total of 2550 women were included in the study (Figure 2). Twenty-two women miscarried and 82 women withdrew or were not contactable during follow-up. Of these, 15 were known to have travelled outside the study area and three were not pregnant. During the study period 5 women died as a result of direct obstetric complications.

Mentions:
The study comprised 24 primary health care facilities and pregnant women attending antenatal care at these facilities. Clusters eligible for randomization were the four primary health care facilities in each of the six districts of Unguja Island with the most antenatal care visits in the previous year and a midwife among the staff. There were no major differences between included facilities. They were all primary health care facilities staffed with 1 or 2 midwives and access to basic infrastructure and equipment. The distribution of facilities in relation to hospitals providing Emergency Obstetric and Neonatal care was the same in intervention and control clusters (Figure 1). The eligibility criteria for participants was pregnant women who attended their first antenatal care visit at 1 of the 24 primary health care facilities regardless of gestational age or mobile phone ownership. A total of 2550 women were included in the study (Figure 2). Twenty-two women miscarried and 82 women withdrew or were not contactable during follow-up. Of these, 15 were known to have travelled outside the study area and three were not pregnant. During the study period 5 women died as a result of direct obstetric complications.

Bottom Line:
The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93).Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.

Affiliation:
Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark. stine_lund@dadlnet.dk.

ABSTRACT

Background: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse.

Objective: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting.

Methods: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality.

Results: Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).

Conclusions: Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.